Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Cell Phone *

(###)

###

####

What type of membership are you requesting? *

: Single - $150/yearly with a one-time $50 initiation fee. : Family - (up to 4 persons in the same household) $350/yearly with one time $50 initiation fee ($50 initiation fee covers everyone) : Corporate - (up to 10 employees) $750/yearly with one time $125 initiation fee (initiation fee covers up to ten employees)

Single Membership

Family Membership

Corporate Membership

Other

Do you hold a current Texas License to Carry (LTC) *

Yes

No

Rate your experience with handguns *

Beginner

Intermediate

Expert

Rate your experience with rifles *

Beginner

Intermediate

Expert

Have you ever been adjudicated as mentally defective, been committed to mental institution, or have any history of mental illness? *

Yes

No

Are you a user of, or addicted to any depressant, stimulant, or narcotic drug, or any other controlled substance? *

Yes

No

By checking the box, I certify the name on the form is myself and the above information is true and correct and I as well as any guest are not prohibited from owning or using or being in the presence of firearms by Federal Authority. Furthermore, I agree to not bring any illegal or prohibited forms of firearms onto Fortis Defense, LLC property. I also certify that I have read and understand and will abide by all Range Rules posted on the Fortis Defense, LLC website and property and that these rules are subject to change. I understand the failure to abide by the rules WILL result in termination of membership. Fortis Defense, LLC also reserves the right to terminate any membership with or without cause. *

I CERTIFY